A Brief History of Brachytherapy - Key milestones.

Click on the milestones below to discover more about the development of brachytherapy.

 

 

 

The early pioneers resorted to the method of inserting bulky radium tubes within the tumor for a certain period of time before withdrawing them. In 1914, Stevenson and Joly improved the technique by using pure radium sulphate, thus manufacturing the first radium “needles” made from steel or platinum. A different method was worked out during the same period at Memorial Hospital by Failla, who collected radon gas in tiny glass tubes that were then inserted into tumors and left there indefinitely.1

 

It’s often assumed that prostate brachytherapy was first performed in the second half of the 20th century. In actuality, radium sources were used in the treatment of prostate cancer many decades earlier by several prominent urologists. The leading innovator was Benjamin Barringer, who performed hundreds of transperineal implants beginning in 1915.2

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A record of a course of intracavity brachytherapy as delivered by Hugh Hampton Young.

(a) Map of prostate and seminal vesicles as determined by rectal examination. Parallel lines indicate regions of induration, and cross-hatched areas indicate stony hardness.

(b) Record of rectal applications.

(c) Record of urethral, bladder neck, and trigonal applications.

(d) Palpable findings 10 months after therapy completion.
Hugh Hampton Young is also known for developing the radical perineal prostatectomy in 1904.3

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Transrectal intracavity application using an applicator and fixation device of Young’s design. The tip of the applicator contained a 100 mCi radium source, encased in platinum and rubber (to filter the alpha, beta and secondary X-rays). Daily applications were alternated between the rectum, urethra, or bladder, and no mucosal segment was irradiated twice. Daily “seances” (treatment sessions) typically delivered 100-200 mg-h.3

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Insertion of an emanation-tipped needle using a transperineal approach, under guidance of a finger in the rectum. Young initially reported dramatic results, with “amazing reabsorption of extensive carcinomatous involvement of prostate and seminal vesicles... in the majority of cases,” resulting in the "disappearance of pain and obstruction.. which is indeed remarkable." 3, 4

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Gold radon-bearing seeds. Note the chiseled ends, produced when a long gold tube is divided into short sections by crimping and cutting. Gold seeds replaced glass sources at Memorial Hospital by 1926. To a significant extent, permanent implantation of seeds replaced radium needle applications at this time.5

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Radiograph of pelvis demonstrating the position of intraprostatic gold-sheathed radon (“emanation”) seeds. This patient had undergone several implants.3

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Devices for seed implantation.

(A) Memorial Hospital began implanting with a simple trocar and stylet. Each puncture could implant a single seed, which was placed into the tip of the trocar (with forceps) and fixed in place by wax.

(B) Breech-loading implant needle used at the London Radium Institute. It allowed implantation of a series of seeds without removing the needle for reloading.

(C) Seed gun used at the London Radium Institute. Preloaded cartridges of 10 seeds allowed implantation without interruption for reloading. 5

 

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Benjamin Barringer’s work is commemorated by the Barringer Medal, awarded since 1955 for research contributing to the advancement of clinical urology. (a) Barringer’s image is on the face of the medal. (b) Symbols of radioactivity, as well as “seeds” and an implanting trocar, appear on the medal’s reverse.3

 

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The needles should be inserted into the gland until the tips can be sensed in the rectum by the index finger of the operator or his assistant.1

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Permanent Interstitial Brachytherapy: Retropubic Approach, Circa 1970.1

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l-25 seed characteristics

(a) 6711 silver-wire seed*
(b) 6711 isodose rate contours
(c) 6702 no-marker seed
(d) Capsule appearance
*Medical Surgical Division, 3M Company, St Paul, MN.

In early 1970, Felix Mick was asked to develop a low energy source known as l-125. Iodine pellets were encapsulated in titanium tubing and irradiated at the Union Carbide reactor in Tuxedo NY. Later Lawrence Softray, Inc. took over and produced the first commercially available seeds.1, 6

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The first generation of Mick® applicators was developed in 1973 to gain better control over loose seeds and add radiation protection. Seeds were contained in shielded cartridges while the applicator was designed according to the “afterloading principle” developed by Professor Ulrich K. Henschke, MD.,PhD.1, 6

 

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The Memorial Nomograph for Iodine-125 Volume Implant. This began as a guide for seed spacing in implementing the original average dimension method of total source-strength specification.1

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Andy Grove’s (then CEO of Intel®) decision to share the story of his diagnosis of prostate cancer, decision making process and treatment was published in Fortune®. Many men and their families were inspired to seek out the various options available to them, including prostate brachytherapy.

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Lee et al report on improved dosimetric coverage achieved with RAPID Strand™

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Al-Qaisieh et al report that use of RAPID Strand™ eliminated seed emobilization to the lung.

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Oncura launches RAPID Strand™ Rx – the first prescription-based, pre-loaded brachytherapy kit.

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Sylvester et al report 15-year relapse-free survival rates showing excellent long-term disease control.

Launch of www.myprostatecanceroptions.com patient education website, sponsored by Oncura.

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Oncura launches BrachyBase™– a secure, web-based prostate brachytherapy patient data registry.

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  1. Basil S. Hilaris, Dattatreyudu Nori, Lowell L. Anderson. Atlas of Brachytherapy. Copyright© 1988, Macmillan Publishing Company, a division of Macmillan, Inc. Printed in USA.
  2. Jesse N. Aronowitz. Benjamin Barringer: Originator of the Transperineal Prostate Implant. Urology 60: 731-734, 2002.
  3. Jesse N. Aronowitz. Dawn of Prostate Brachytherapy: 1915-1930. Int. J. Radiation Oncology Biol. Phys., Vol. 54, No. 3, pp. 712-718, 2002.
  4. Young HH. Technique of radium treatment of cancer of the prostate and seminal vesicles. Surg Gynecol Obstet 1922; 34: 93-98. Ref #6, Jesse N. Aronowitz:Dawn of Prostate Brachytherapy: 1915-1930. Int. J. Radiation Oncology Biol. Phys., Vol. 54, No. 3, pp. 712-718, 2002.
  5. Jesse N. Aronowitz. Buried emanation: the development of seeds for permanent implantation. Brachytherapy 1 (2002) 167-178.
  6. Mick Radio-Nuclear Instruments, Inc., 521 Homestead Ave, Mount Vernon, NY 10550. http://www.micknuclear.com/Page_History/historical1.asp.
  7. Davis, B.J., Pisansky T.M., Wilson T.M., et al. The Radial Distance of Extraprostatic Extension of Prostate Carcinoma: Implications for Prostate Brachytherapy.
    Cancer, Vol. 85, No. 12, 1999.
  8. Peter D. Grimm, John C. Blasko, John E. Sylvester: The Prostate Cancer Treatment Book. Copyright © 2004, McGraw-Hill.
  9. Kent Wallner. Prostate Cancer, A Non-Surgical Perspective: Copyright 1996 © Kent E. Wallner, SmartMedicine Press, Canaan, New York.